2026 ACA Payment Notice
CMS released its annual proposed 2026 Notice of Benefit of Payment Parameters which sets forth key regulations that affect the individual and small group market. The proposed rule includes tightening rules around agents and brokers, changes to the medical loss ratio for certain issuers, potential changes to the risk adjustment program (namely creating a new factor for PrEP), as well as other changes. Wakely will release a more detailed summary of the proposed rule soon.
On the Campaign Trail
Vice President Harris released a proposal this week proposing to broaden Medicare benefits to include home health care. While exact details are still forthcoming, the campaign mentioned that the expansion would at least be partially paid for by increasing the number of drugs Medicare could negotiate on.
State Issues
There are a number of health-related state ballot initiatives that will be voted on this fall. They include increasing taxes on managed care plans in California, Medicaid work requirements in South Dakota, and Washington considering operating long-term care insurance program.
Employer Premiums
KFF annual survey of employer-sponsored insurance found that ESI premiums in 2024 are $8,951 for single coverage and $25,572 for family coverage. This represents an increase of 6% for single coverage and 7% for family coverage. The percentage of covered workers in self-funded plans is similar to last year.
CBO on Anti-Obesity Medications
CBO estimates that Congress authorizes Medicare to cover anti-obesity drugs would increase federal spending by about $35 billion from 2026 to 2034. This includes direct costs increases of about $1.6 billion in 2026 to $7.1 billion in 2034 and savings from improved health ranging from $50 million in 2026 to $1.0 billion in 2034.
